Stimulus-control: nonpharmacologic treatment for insomnia.
OBJECTIVE
To evaluate the efficacy and applicability of a behavioural treatment for insomnia that can be administered by family physicians in various clinical settings.


METHODS
Efficacy of the treatment was evaluated by single-case experimental designs (multiple baseline across subjects). Applicability was assessed through semistructured interviews with physicians.


METHODS
Two private offices, two offices in community health centres, and one office in a family medicine unit.


METHODS
Six general practitioners and 24 chronic insomniac patients recruited through media advertisements and from physicians' practices. Of an initial 38 subjects screened, six were excluded for sleep-onset latency less than 30 minutes, five for psychological conditions, one for physical handicaps, and two for other reasons.


METHODS
Physicians used stimulus-control treatment during individual therapeutic sessions. Patients using hypnotics were encouraged to taper off their medications after treatment was initiated.


METHODS
Time it took patients to get to sleep (sleep-onset latency), amount of hypnotic use, and practitioners' evaluation of the treatment.


RESULTS
Fifteen patients completed the treatment; 80% of them reduced their sleep-onset latency. Six of the seven patients using hypnotics at the beginning of the study reduced or stopped their medications. All therapeutic gains were maintained at 3 and 6 months. Physicians thought stimulus-control treatment could be used in medical practice, but specified that it was most useful for highly motivated patients.


CONCLUSIONS
Family physicians can use stimulus-control treatment effectively for patients with chronic insomnia. This nonpharmacologic approach could help motivated patients reduce their use of hypnotics.
Baillargeon
L
L
Family Medicine Department, Laval University, Quebec City.
Demers
M
M
Ladouceur
R
R
D000328:Adult; D001521:Behavior Therapy; D002908:Chronic Disease; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D012890:Sleep; D007319:Sleep Initiation and Maintenance Disorders / Q000628:therapy*; D016896:Treatment Outcome
D006993:Hypnotics and Sedatives